A Tale of Two Knees Part III

Ministerial Meandering

A tale of two knees - Part 3

He was Royal Air Force - but nobody’s perfect - and had a dodgy knee.  Okay - so after the last two ‘episodes’, you all know everything there is to know about knees now, and this is going to be a bore.  Tough - suck it up.  It’s all you’re getting.

He was a pleasant young man, tall, and committed to his fiancée, who was also present at the initial consultation.  Their problem was that they couldn’t see their way ahead in life - all because of his knee; the left one, as it turned out.

The story was that at some time in the past, whilst playing soccer, he had injured his cruciate ligaments.  The anterior cruciate is a classic to ‘go’ in soccer injuries.  He had been playing for his unit, so - in a sense - this was an injury sustained whilst on duty, in contradistinction from our Army colleague.

The Defence Medical Services prides itself on the number and range of orthopaedic specialists - most likely because we deal with a large number of young, fit men and women, who like to play sports hard - and consequently get injured.

Our RAF man had seen several of these specialists.  He had had his cruciate repaired, not once, but three times - with no success, and remained with an unstable knee, requiring him to walk with a stick (cane) for safety.

During his many stays in hospital, on bed-rest following his procedures, he developed deep venous thrombosis (DVTs) in his affected leg, and recurrent pulmonary emboli - blood clots moving up from the leg and into the lungs; a potentially lethal complication.  The treatment for this is anti-coagulation (blood-thinners), which he had.  The problem was that every time he stopped the anti-coagulants he would have another pulmonary embolus - which was pretty scary, both for him and his fiancée.

There is another way to stop the clots from moving up from the legs to the lungs, and that is by way of placing what is known as an IVC filter.  That is a sort of sieve that is placed upside-down into the main vein of the abdomen (IVC = Inferior Vena Cava), which allows fluid blood to pass through, but catches the clots before they reach the lungs, and possibly kill the patient.

These filters can become occluded themselves in time, and require very powerful clot-dissolving medication (thrombolytics) intravenously, which is far more risky than clot-preventers (the anti-coagulants).  These thrombolytics are only used in hospital, usually in an ICU setting.

He had gone through all of these procedures and complications, and was now left with his unstable knee, his leg full of blood clot, an IVC filter that required thrombolysis periodically, and a career in the RAF (he was a mechanic) that was on the skids.

Add to this the bizarre fact that because of all the blood-thinners, which he would have to be on for life, he had now developed haemospermia - blood in his sperm.

Now usually this does not affect the fertility of the sperm, and men with this condition (there are many other causes) can go on to father children with no trouble - so long as they have found a woman to have them with - which he had.

But in our man’s case, for some odd reason that neither the haematologists nor the sexual medicine gurus could explain, whenever he had haemospermia (which was most of the time), his sperm motility and viability went down drastically, to a point where it would have been very difficult for the couple to have children in the ‘normal’ way.

So here is our problem; a young man in his early 30’s, wanting to get married and start a family, but infertile due to his anti-coagulants, which are required because of the thrombosis in his dodgy leg, and an IVC filter to save him from being killed by a pulmonary embolus lodging in his lungs, with career prospects looking anything but rosy.

And having been passed from pillar to post over several years, someone - in desperation perhaps - sent him to see me.

Philip+